Document Type


Degree Name



Dept. of Medical Informatics and Clinical Epidemiology


Oregon Health & Science University


In 2011, almost 4 million babies (Hamilton, Martin, and Ventura 2011) were born in the United States, with approximately 12% of those being premature (Hamilton, Martin, and Ventura 2011). About 10% of newborns require some form of resuscitation to begin breathing at birth with about 1% requiring extensive resuscitation effort to survive (ILCOR 2006). Karlsen et. al. (2011) reported the median neonatal transport volumes of as many as 68,797 critically ill neonates being transported each year in the United States. These transports require a coordinated effort with highly trained personnel, specialized equipment and ambulances. There are also more than 8.7 million children and teenagers who were treated for an injury in United States Emergency Departments and more than 225,000 of these children had injuries serious enough that required hospitalization or transfer to another facility with a higher level of care (CDC 2012). Pediatric visits account for about 27 percent of all visits to emergency departments in the United States (IOM 2010). About one percent of children who visit Emergency Departments are transferred to another facility for a higher-level of care (IOM 2007). Specialized neonatal/pediatric transport teams are trained to deal with specific needs of this unique population and have the equipment and expertise necessary to bring essential therapies usually only provided at the tertiary facility to the bedside at the referring facility and community emergency departments. vii Many Emergency Medical Services (EMS) have developed an electronic medical record, which is usually called an Electronic Patient Care Report (ePCR). The ePCR is similar to an electronic medical record (EMR), but has documentation streamlined for the pre-hospital situations and other aspects that are not found in commercial EMRs. Most neonatal and pediatric specialized transport teams are part of children’s hospitals and have close connections with local EMS providers that utilize ePCRs. It is because of this camaraderie that some of the neonatal and pediatric specialized transport teams have adopted their local EMS provider’s ePCR as their electronic health record for their documentation need while on these neonatal and pediatric transports. One specific article that looked at implementation of electronic medical records in the pre-hospital setting (Landman et. al. 2012) used in-depth interviews with key informants. The 20 EMS agencies surveyed by Landman (2012) do adult EMS transports and made no mention of neonatal or pediatric transports. Landman et. al. (2012) came up with four themes: financial, organizational, technical and privacy/security. In this synthesis paper, we will explore the barriers to implementation of an electronic health record in the neonatal and pediatric transport environment as they relate to the unique and demanding conditions seen on neonatal and pediatric critical care transports.




School of Medicine



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